CGL Pathways to Recovery
Outstanding

Inspection Summary

Overall summary & rating

Outstanding

Updated 12 February 2020

We rated CGL Pathways to Recovery as outstanding because:

The service provided safe care. The premises where clients were seen were safe and clean. The number of clients on the caseload of the teams, and of individual members of staff, was not too high and staff ensured that people who required urgent care were seen promptly. Staff assessed and managed risk well and followed good practice with respect to safeguarding.

Staff developed holistic, recovery-oriented plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the clients and engaged in clinical audit to evaluate the quality of care they provided.

The teams included or had access to the full range of specialists required to meet the needs of the clients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multi-disciplinary team and with relevant services outside the organisation.

Staff treated clients with dignity, respect, compassion and kindness and understood the individual needs of clients. There was a strong person-centred culture. The service had a culture of coproduction which ensured clients were active partners in their care. Staff empowered clients to have a voice and realise their potential. Clients individual needs and preferences were reflected in the way care was delivered. Clients were supported to access community support services and networks.

Clients were active partners in the delivery, review and development of the service. There was a developing service user forum and clients held service user representative roles. The service was proactive in securing client feedback and used this to inform service development.

The service was easy to access. Staff assessed and treated people who required urgent care promptly and those who did not require urgent care did not wait too long to start treatment. The service did not exclude people who would have benefitted from care.

There was compassionate, inclusive and effective leadership at all levels. Managers were a visible presence. There were clear vision and values embedded within the service. Effective governance processes ensured that managers had a clear overview of service performance. There was a commitment to service improvement and innovation. Clients and staff were active participants in service development projects. Service improvement plans had been developed and delivered.

There were high levels of staff satisfaction. Staff reported that they felt empowered, recognised, valued, supported and were encouraged to develop their knowledge and skills. Team morale was strong, and staff worked collaboratively within the team and with external agencies. There was an open and honest culture. Staff felt able to raise concerns without fear of reprisal.

The service was well led, and the governance processes ensured that procedures relating to the work of the service ran smoothly.

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Inspection areas

Safe

Good

Updated 12 February 2020

We rated safe as good because:

All clinical premises where clients received care were safe, clean, well equipped, well furnished, well maintained and fit for purpose.

The service had enough staff, who knew the clients and received training to keep people safe from avoidable harm. The number of clients on the caseload of the teams, and of individual members of staff, was not too high.

Staff assessed and managed risks to clients and themselves. They developed recovery and risk management plans when this was necessary and responded promptly to sudden deterioration in a client’s health.

Staff understood how to protect clients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.

Staff kept detailed records of clients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.

The service managed client safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents with staff, peer mentors and volunteers. Lessons learnt were shared with the whole team. When things went wrong, staff apologised and gave clients honest information and suitable support.

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Effective

Good

Updated 12 February 2020

We rated effective as good because:

Staff assessed the treatment needs of all clients. They developed individual care plans and updated them when needed. Care plans reflected the assessed needs, were personalised, goal focussed and recovery-oriented and staff updated them when appropriate.

Staff provided a range of care and treatment interventions suitable for the client group. They ensured that clients had good access to physical healthcare and supported clients to live healthier lives.

The teams included or had access to the full range of specialists required to meet the needs of clients under their care. Managers made sure they had staff with a range of skills needed to provide high quality care. They supported staff with appraisals, supervision and opportunities to update and further develop their skills. Managers provided an induction programme for new staff.

Staff from different disciplines worked together as a team to benefit clients. They supported each other to make sure that clients had no gaps in their care. The teams had effective working relationships with other relevant teams within the organisation and with relevant services outside the organisation.

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Caring

Clients were truly respected and valued as individuals and were empowered to be partners in their care, practically and emotionally, by an inclusive service.

Staff treated clients with dignity, respect, compassion and kindness. They understood the individual needs of clients and supported clients to understand and manage their care, treatment or condition.

Feedback from clients and commissioners was consistently positive about the way staff treat people. Clients told us their care and support surpassed their expectations.

Staff involved clients in care planning and risk assessment and actively sought their feedback on the quality of care provided. Relationships between clients and staff were strong, caring, mutually respectful and supportive. These relationships were highly valued by staff and clients. Clients told us they felt really cared for and that they mattered.

There was a visible person-centred culture, with highly motivated and inspired staff who offered care that was kind and promoted clients’ dignity. Relationships between people who use the service, those close to them and staff are caring, respectful and supportive. These relationships are highly valued by staff and managers.

Staff were fully committed to working in partnership with clients and empowered them to have a voice and to realise their potential. Clients contributed toward the development of and improvements to the services provided.

Clients’ emotional and social needs were recognised as being as important as their physical needs.

Staff informed and involved families and carers appropriately in clients’ care and treatment. The service offered opportunities for clients to be involved in their care through educational, vocational and personal development courses through a partner agency to deliver education and training support to clients and their families to access employment or voluntary work. Clients are supported by two employment training workers and or staff to complete applications for education courses, employment and voluntary work.

The service had access to, and strong links with, support networks in the community and staff supported clients to use them. The service recognised clients needed to have access to, and links with, their advocacy and support networks in the community and they supported clients to do this. works Pathways to recovery provided clients with information about community projects and courses available in Warrington and signposted clients to other agencies offering training and employment. It also provided a tutor from the local college to support clients to complete their BTEC Level 2 in Health and Social Care.

The service found innovative ways to enable clients to manage their own health and care when they could and to maintain independence as much as possible. In August 2019 the service ran a four week’s event based on a well know children’s storey. The project was suggested at a service user forum, which highlighted that during school holidays clients found difficulty in attending the service due to childcare commitments. The project was discussed with the management team whom supported the idea. Activities were designed and supported by clients, volunteers, peer mentors and staff. The project had a total number of 58 attendees over the four weeks.

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Responsive

Good

Updated 12 February 2020

We rated responsive as good because:

The service was easy to access. Its referral criteria did not exclude people who would have benefitted from care. Staff assessed and treated people who required urgent care promptly and people who did not require urgent care did not wait too long to start treatment. Staff followed up people who missed appointments.

The teams met the needs of all people who use the service, including those with a protected characteristic. The hub had access for those with disabilities, access to interpreters and information in other languages, as well as easy read versions for clients.

The service supported clients to engage with their communities. Staff offered clients opportunities to volunteer in the service and other community projects and be supported into education, training and employment.

The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.

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Well-led

The leadership, governance and culture in the service was used to drive and improve the delivery of high-quality person-centred care.

There were compassionate, inclusive and effective leaders at all levels. Leaders had the skills, knowledge and experience to perform their roles and deliver high level sustainable care. Leaders had a good understanding of the teams they managed and were visible in the service and approachable for clients and staff.

Leaders had a creative and shared purpose which fostered a culture of partnership within the service, that ensured clients were active participants in their own care, and the delivery of the service.

There was a culture of understanding the challenges the service faced and prioritising service development for the future with a limited budget. There was a commitment to modernise and improve the service. Service development plans were based on working in partnership with stakeholders on what was achievable within the local area. Service development plans were consistently monitored and delivered.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. Vision and values were embedded in the delivery of care. Staff were proud of the organisation as a place to work and spoke highly of the culture. Staff at all levels were actively encouraged to speak up and raise concerns. There were high levels of staff satisfaction across the service.

Staff felt respected, supported and valued. Team morale was good and there was collaborative team working and support across the service. Staff reported that the provider promoted equality and diversity in its day to day work and in providing opportunities for career progression.

Staff at all levels were actively encouraged to speak up and raise concerns, and all policies and procedures positively support this process. Staff

Our findings from the other key questions demonstrated that governance processes operated effectively at team level and that performance and risk were managed well. The service had a systematic approach to working with other organisations to improve care outcomes.

Teams had access to the information they needed to provide safe and effective care and used that information to good effect. Managers had access to up to date and robust information on service performance.

An innovative approach was taken to working with clients and stakeholders to introduce new models of care. There was a strong record of sharing work locally with stakeholders and commissioners.

Inspection ratings

We rate most services according to how safe, effective, caring, responsive and well-led they are, using four levels:

Outstanding – the service is performing exceptionally well.

Good – the service is performing well and meeting our expectations.

Requires improvement – the service isn't performing as well as it should and we have told the service how it must improve.

Inadequate – the service is performing badly and we've taken enforcement action against the provider of the service.

No rating/under appeal/rating suspended – there are some services which we can’t rate, while some might be under appeal from the provider. Suspended ratings are being reviewed by us and will be published soon.

Ticks and crosses

We don't rate every type of service. For services we haven't rated we use ticks and crosses to show whether we've asked them to take further action or taken enforcement action against them.

There's no need for the service to take further action. If this service has not had a CQC inspection since it registered with us, our judgement may be based on our assessment of declarations and evidence supplied by the service.

The service must make improvements.

At least one standard in this area was not being met when we inspected the service and we have taken enforcement action.